15 They may meet criteria for type 1 MI, where epicardial coronary artery disorders are diagnosed, or type 2 MI due to endothelial dysfunction or oxygen supply and demand mismatch, or myocardial injury. MINOCA disorders can be classified within the fourth universal definition of MI.

This working diagnosis then requires further investigation to establish the underlying pathophysiology for the presentation and prevent inadequate or inappropriate therapeutic strategies.

12,13 Approximately one-third of patients have been reported to present with suspected STEMI within an emergency setting and the remaining majority as NSTEMI patients undergoing subsequent angiography. In a patient presenting with symptoms of ischaemia, cardiac enzyme elevation and echocardiographic or electrocardiographic features suggestive of acute MI, a working diagnosis is made during angiography in the absence of culprit obstructive coronary artery disease (epicardial coronary artery stenosis в‰Ґ50%) or an apparent systemic cause for the presentation. The diagnosis of MINOCA is dependent on the presence of clinical acute MI and the absence of obstructive coronary disease. It is important to reach a definitive diagnosis because MINOCA patients have impaired survival rate compared with age- and sex-matched healthy individuals. 6вЂ“8 Accurate diagnosis and subsequent management require the appropriate utilisation of intravascular imaging and coronary function testing, in addition to echocardiographic and cardiac MRI (CMR) to assess for the presence of infarction or myocardial disorders without coronary involvement. 4,5 Compared with obstructive coronary artery disease, factors associated with MINOCA include female sex, younger age (<55 years), genetics and physiological stress. 2,3 MINOCA occurs in 5вЂ“15% of patients presenting with acute ST-segment elevation MI (STEMI) or non-ST segment elevation MI (NSTEMI), depending on the observed population and definition used. 1 MINOCA is not a benign diagnosis, with outcomes similar to those of patients with acute MI and obstructive coronary disease up to 1В year (12-month mortality 0.6% versus 2.3%, respectively p=0.68). DVLA might arrange for you to have specific tests, depending on your condition.MI with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of vascular or myocardial disorders that was first reported over 80 years ago. You must take an assessment with your doctor or GP after 6 weeks to see if you meet the medical standard to start driving again. You must tell DVLA and stop driving for 6 weeks if youвЂ™ve had a heart attack (myocardial infarction) or a heart, cardiac or coronary angioplasty.ДЇill in form VOCH1 and send it to DVLA. 4 weeks if you had a heart attack but didnвЂ™t have angioplastyД¬heck with your doctor to find out when itвЂ™s safe for you to start driving again.

4 weeks if you had angioplasty after a heart attack but it wasnвЂ™t successful.1 week if you had angioplasty, it was successful and you donвЂ™t need any more surgery.You donвЂ™t need to tell DVLA if youвЂ™ve had a heart attack (myocardial infarction) or a heart, cardiac or coronary angioplasty. You may be prosecuted if youвЂ™re involved in an accident as a result. You can be fined up to ВЈ1,000 if you donвЂ™t tell DVLA about a medical condition that affects your driving.

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